Quality of life and mortality in older adults with sepsis after one-year follow up: A prospective cohort study demonstrating the significant impact of frailty.

ABSTRACT

BACKGROUND: Survivors of sepsis often develop chronic critical illness after the inflammatory stage, resulting in death or hospital readmission. The long-term prognosis of older patients with sepsis and the associated factors, particularly frailty, are not well studied. OBJECTIVES: To investigate the effect of frailty on the quality of life (QoL) and mortality in older patients after one year of sepsis diagnosis. METHODS: This prospective study included patients admitted to a specialized geriatric intensive care unit between May 2018 and April 2019. Patients were grouped according to the Clinical Frailty Scale as severely frail, mildly to moderately frail, and non-frail/vulnerable. The primary outcome was QoL one year after sepsis diagnosis, measured using the European QoL 5-Dimension (EQ-5D) and 12-item Short Form. The secondary outcome was one-year survival. RESULTS: Of the 211 participants, 75 (35.5%) completed the QoL surveys. Of them, 37 (49.3%) did not return to their baseline QoL one year after sepsis diagnosis. The rate of reported mobility problems (a dimension of the EQ-5D) increased by 100% during the year. Additionally, survivors in the severely frail group exhibited poorer QoL at one year than those in the mildly to moderately frail and non-frail/vulnerable groups. The one-year mortality in the severely frail group was 75.9%, with an adjusted hazard ratio of 1.70 (95% confidence interval, 1.02-2.82, p = 0.041). CONCLUSIONS: Frailty significantly impacts the one-year prognosis in older patients with sepsis. This research highlights the need for frailty management and physical rehabilitation in frail older patients at risk of poor prognosis, with implications for improving transitional and post-acute care services.